Older members of the military, veterans and military retirees may be eligible for TRICARE, which is the health care program of the United States Department of Defense’s Military Health System.
Americans who are over 65 years old or who have a qualifying disability are eligible for Medicare, the federal health insurance program. But if a person is eligible for TRICARE, can they also receive Medicare benefits and vice versa?
The short answer is yes, you can have Medicare and TRICARE for health coverage. This guide will help you learn more about how these forms of health insurance can work together.
How Medicare works with TRICARE
TRICARE For Life (TFL) is TRICARE’s optional health plan that is designed for military members and retirees who are also Medicare beneficiaries.
In the U.S. and U.S. territories, Medicare serves as the primary coverage for people enrolled in both programs, and TRICARE offers secondary coverage.
This means that Medicare will receive your medical bill first and pay its share of qualified medical costs before forwarding the remaining charges to TRICARE. TRICARE then pays the remainder of covered services. In some cases, you may be left with no out-of-pocket expenses for qualified care.
If you receive care in locations outside of the U.S. and U.S. territories, TRICARE becomes the primary payer, and Medicare offers secondary coverage. The process outlined above then works in reverse order, with Medicare covering any qualified costs after TRICARE has paid its share.
In all cases, TRICARE acts as the primary payer for any services that Medicare does not cover, as long as TRICARE provides coverage for that service.
Under TRICARE For Life, you may receive care from each of the following health care providers:
- Medicare-participating providers
A Medicare-participating provider has agreed to accept the Medicare-approved amount as full payment for qualified services. This is known as “accepting assignment.” - Medicare non-participating providers
A Medicare non-participating provider has not agreed to the Medicare-approved amount for their services, and they reserve the right to charge up to 15 percent more for covered services. In this case, TRICARE For Life covers the cost of any such Medicare excess charges. - Medicare opt-out providers
A Medicare opt-out provider does not contract with Medicare and will bill Medicare patients directly. In this case, TRICARE For Life will cover the amount that it normally would cover if Medicare had been able to pay (which is typically around 20 percent of the total charge).
How TRICARE works with other types of Medicare coverage
Below is how TRICARE For Life works with other types of Medicare.
- Medicare Advantage
TRICARE works with Medicare Advantage plans (Medicare Part C) in the same way that it works with Original Medicare (Medicare Part A and Part B) as described above.
Medicare Advantage plans offer the same benefits covered by Original Medicare, and some Medicare Advantage plans may also offer additional benefits such as dental, vision and hearing care, as well as prescription drug coverage. - Medicare Part D
TRICARE includes prescription drug coverage. In many cases, it isn’t necessary for TRICARE beneficiaries to enroll in a Medicare Part D prescription drug plan. - Medicare Supplement Insurance
TRICARE acts as supplemental coverage and picks up the cost of many of the same out-of-pocket Medicare costs as Medicare Supplement Insurance, such as Medicare coinsurance and deductibles. For this reason, it’s not typically necessary for TRICARE beneficiaries to enroll in a Medicare Supplement Insurance plan (also called Medigap).
TRICARE and Medicare eligibility
In order to enroll in TRICARE For Life, you must be eligible for and enrolled in both Medicare Part A and Part B and be eligible for TRICARE.
TRICARE eligibility is available to:
- Military members and their families
- National Guard/Reserve members and their families
- Survivors
- Some former spouses
- Medal of Honor recipients and their families
There is no cost to join TRICARE For Life or to maintain coverage. You will, however, have to pay your monthly premium for Medicare Part B.
Learn more about your Medicare Advantage plan options
For information about Medicare eligibility, benefits and the Medicare Advantage plan options available in your area, speak with a licensed insurance agent by calling TTY Users: 711 24 hours a day, 7 days a week.
